ER Physician Assistant

Physician Assistants are clinicians who work under the direct supervision of a Physician. The amount of supervision a PA requires depends on several things:
1. State legal statutes governing PAs
2. Your supervising physician: Generally speaking, the more a physician trusts your skills the more you will be able to do within the scope of your chosen practice. Some physicians/groups are much more lenient than others and appreciate the extra help and input. Certain physicians will go out of their way to teach and make sure that the PA is well-informed and adequately skilled so that they can be left to treat patients on their own. However, there will always be those physicians who only want PAs to do histories and physicals - although, they are few and far between.
3. Hospital by-laws and credentialing: If you are working in a hospital, you will have to abide by the laws that they set forth for what a PA can or cannot do. Most of the time, this will fall back to the supervising physician and what they feel is within your scope of practice.

Working in the ER can be very challenging.

Contrary to what we see on popular t.v. shows like 'ER' and 'House', the ER isn't always glamorous nor busy with multiple traumas. Of course, bigger metropolitan hospitals and teaching hospitals will have much more trauma and acute medicine than say a small community hospital. Nonetheless, don't be fooled into thinking you want to work in ER medicine because it's 'exciting'.

When I say that working in the ER can be 'challenging' I mean that you will be busy and you will work hard. Most ER shifts are 12 hours, and since ERs don't close that means days AND nights. Don't forget, you will work weekends and holidays, too.

Sadly, much of the medicine we practice today in the ER is primary care. Meaning, many of our patients come to be seen for common colds, sprains/strains, and prescription medicine refills. It seems hard to believe that people would spend hours waiting to be told they have a cold, but they do and this clogs up the waiting room. Because of this problem, another branch of the ER has been created called 'Fast Track'.

Many PA's work in ER Fast Tracks. There PAs see the lower acuity patients, so that the physicians have more time (and rooms) to see the more serious patients. Working in the Fast Track area means more autonomy for the PA because generally they work with a nurse and a tech, while the physician stays in the main ER. Generally speaking, a PA will see, diagnose and treat common problems such as suture placement/removal, common colds, orthopedic sprains/strains, minor fractures, toothaches, medication refills, strep throat, and other minor primary care issues.

In many hospitals, PAs continue to work in the main ER and see higher acuity patients as part of the ER team. Some PAs place chest tubes, central lines, intubate/help run codes, perform lumbar punctures, and other more advanced ER medicine/procedures.

There are several great resources for finding ER jobs. If you're willing to move, you'll probably have no problem getting an ER job. The biggest obstacle with getting an ER job, however, is experience. Many ERs want PAs with at least 3-5 years of ER experience. This makes it hard to break into emergency medicine if you've never worked in an ER before.

Sometimes, urgent care clinics will take new graduates or PAs without previous ER or urgent care (fast track) experience. Another option is to work for an urgent care clinic or an ER on a part-time or PRN (as needed) basis. That way you can get your foot in the door and learn the ropes, and in a few years you'll have the 3-5 years experience you need to get a full time job.

Great resources for finding ER jobs are SEMPA (Society for Emergency Medicine PAs), AAPA (American Academy of Physician Assistants), and your state PA organization websites. I've also seen quite a few ads for ER positions on Monster.com.